Vineyard Voices: We say goodbye to 2005 with a glance back and a look forward to the New Year

Posted December 29, 2005

As we have for the past several years, The Times asked several Vineyarders to describe their unique observations of this Island moment in time for our last issue of the year. We extended invitations to leaders in the public and private sector, some with incumbent responsibilities, some with less onerous obligations, all with considerable experience of how our community works and how it might work in the coming year. Tim Walsh is chief executive officer of the Martha's Vineyard Hospital and has spent much of the year on plans to replace a physical plant that is cramped and leaks when it rains. James Lengyel is the longtime executive director of the Martha's Vineyard Land Bank, the Vineyard's only public land conservation organization and a dedicated champion of public access that mixes recreational use with conservation protection.

John Abrams is the president and CEO of South Mountain Company, a successful construction company. He is a proponent of affordable housing who is involved in a number of Island projects.

Cynthia Mitchell is the chairman of the Dukes County Health Council and executive director of Island Health Inc., a Vineyard non-profit that has opened the rural health clinic in Edgartown and is working to offer a subsidized health insurance plan to employers, and uses her unique vantage point to talk about health care issues facing the Vineyard.

Land Bank: Despite hurdles, Vineyard Land Bank perseveres

By James Lengyel

If the Land Bank were asked to identify one word that best described itself and the way it does business, that word would be ... persistence.

Still ringing in my ears is a comment I heard in 1995 or so from an Island voter. I had asked her what she thought of the Land Bank's progress in the ten years since she had voted, with many others, to create the Land Bank. She answered simply: "I really thought that we would have had more new public beaches by now."

My response to her still stands, ten years later. I told her that the Land Bank is trying, does try, will try - persistence will yield results.

In 2003, results were yielded in Tisbury - the land bank expanded its Wilfrid's Pond preserve on Herring Creek Road, whose beach on the Vineyard Sound now totals 670 feet in length. West Tisbury's turn came in 2004, when the public was at last able to secure ocean access along the Tisbury Great Pond barrier beach (200 feet) and pond access along the Ice House Pond (792 feet). In 2005, it was Edgartown. The land bank purchased 500 feet along the Cape Poge Bay this year and signed a contract to purchase another 280 feet in 2006; these, added to an earlier acquisition, have resulted in a total of 1160 feet of public beach here. In 2005 the land bank also broadened its ownership of lots on the Edgartown Great Pond barrier beach by purchasing additional partial interests there.

Likewise with trails. The land bank has pursued for years its hope for a coast-to-coast, east-west, north-south, cross-island network of public hiking trails. Only in 2005 did the first success arrive: the cross-Chappaquiddick trail, which wanders from Wasque Point up to Hickory Cove. On Martha's Vineyard - known far and wide as the land of "no trespassing" signs - it is remarkable that today anyone can freely wander across the spine of Chappaquiddick Island without fear of being turned away or shrieked at.

A third example is affordable housing. Only in particular, and unusual, circumstances can the Land Bank partner up with any of the Island's affordable housing trusts. The Land Bank long ago pledged to scrutinize each prospective acquisition to determine if a corner could be subdivided off, prior to closing, for purchase by the county housing authority or a cousin. Such corners can be hard to find, because the land bank has to determine that development there will not jeopardize the very conservation values it is seeking to protect on the balance of the land.

In 2005, the land bank finalized its most recent such project. A 16-acre property in Tisbury, off Takemmy Path and owned by Linda Kelsey, was subdivided by the Land Bank so as to separate the existing house from the woodland surrounding it. The total price was prorated between the Land Bank and the Island Housing Trust Corporation (IHTC), resulting in IHTC's purchase of an acre - upon which it then went on to create three affordable dwellings - for a total of $48,430. The remaining 15 acres will be forever wild.

Persistence works. But turn over the coin; what is the opposite face of persistence?

Patience.

There are many Islanders to whom the land bank is appealing for patience. Hunters are waiting to use the Tiasquam River Reservation on the Middle Road in Chilmark, some 85 high acres purchased last year from Robert Harrington. Campers are waiting to see if it will be feasible to resurrect a public campground at the Southern Woodlands Reservation on the Barnes Road in Oak Bluffs, acquired this year from Corey Kupersmith. Birders are waiting for the field restoration project to be completed at the Pennywise Preserve off South 18th Street in Edgartown, which the Land Bank ecologist hopes will tempt the northern harrier to hunt, and possibly nest, there.

There's more. Hikers are waiting for the links in Oak Bluffs and West Tisbury which will cinch the planned cross-town trails in these towns. Swimmers are waiting to enjoy the cool waters of Ice House Pond in West Tisbury.

Ice House Pond, in fact, was in 2005 the source of a first for the Land Bank: for the first time ever in the Land Bank's 20-year history, one of its management plans was rejected by the commonwealth. The plan had called for limited public use of the pond - with special restrictions against access to a unique biological community there known as the "coastal plain pond shore" - and was prepared by the land bank ecologist using the same protocol that earned commonwealth approval on all of the previous management plans.

As a result, the rejection was curious. The good news is that the commonwealth's denial was accompanied by a request for the Land Bank to perform several additional studies, which are currently underway. The plan will be redrafted and resubmitted. It's worth remembering that nobody - other than the expected beneficiaries - has ever cheered a Land Bank beach access plan.

Here as elsewhere the Land Bank will persist. Whatever the Land Bank has already accomplished has been born of persistence. As Herbert Hoover famously observed, talent, genius and education have nothing to do with success (and the Land Bank's critics will be the first to note that the Land Bank lacks talent, genius and education); instead, he said, success comes from only one place - persistence and the willingness to press on.

James Lengyel is the executive director of the Martha's Vineyard Land Bank.

Health Care: A survey of the health care landscape

By Cynthia Mitchell

Invited by the paper to provide comment on the year going and the year coming in health care, and having several vantage points from which to do so (director of a non-profit health care organization, former elected official with long-standing involvement in local health care, and long-time member of the Dukes County Health Council), I find - with some surprise - that the most useful perspective I can offer is as the current chair of the Dukes County Health Council.

In 2006, the Council will mark 10 years of roundtable discussion and group work on the range of local health care issues. By turns, it has provided a venue to react to institutional indifference to community need and to demand accountability; to identify and measure community health needs such as lack of insurance and access to care; to push ahead with plans to address those needs while not moving too fast or too slow for everyone at the table; and to periodically regroup to consider what it is we have done or not done, and to reframe our collective future. Broadly inclusive, imperfect and messy, sometimes kicking and screaming but just as often mutually supportive, some 75 or more members (35 seats with individuals moving in and out over time) from all sides of our health care system over time have steadily expanded their view from a reactive provider-centered focus to a proactive community focus. I believe the results of the Council's work sketch a fair picture of the current landscape and point to an even better one to come.

Council-Created Programs

Vineyard Health Care Access Program - In a renovated county building on New York Avenue in Oak Bluffs, thousands of Islanders including many of our Brazilian residents are able to enroll in Medicaid, reduced fee and free care programs for primary, emergency, hospital and specialty care. The Access Program, created in 1999 by the Health Council, has not only assisted individuals but has also brought considerable revenue to the provider community (notably the hospital and the new rural health clinic) in the form of new reimbursements for services.

The Island Health Plan - Still unlaunched, and now caught up in the legislative debate about a statewide health plan on Beacon Hill, this affordable insurance plan for Islanders hopes to lead the pack of community health plans once the dust settles. Long-awaited but fully developed and ready to go once the powers that be clear the way. Stay tuned.

Island Health Care Rural Health Clinic - Massachusetts' first rural health clinic, and the Island's first community health center, Island Health Care has made dramatic progress toward meeting the needs of uninsured Vineyarders as well as those with health insurance but no access to primary care.

2005 Highlights

The Martha's Vineyard Brazilian Health Report - The Multicultural Committee of the Health Council conducted a survey and assessment of the Brazilian community, which indicated high rates of depression within that population, and also resulted in a recommendation to establish a community-based medical interpreter service to assist the 56% of Brazilians who have limited English-proficiency.

Community Leadership Award for Health Council Programs - Health Care for All, Massachusetts' leading health care policy and advocacy organization awarded the Vineyard Health Care Access Program and Island Health, Inc. its prestigious Community Leadership Award in Boston.

Federal Rural Health Network Planning Grant - The Council's Primary Care Working Group, with the leadership of Martha's Vineyard Hospital, applied for and received funding to hire a consultant and conduct a strategic planning process for primary care services.

Health Forums - In collaboration with other organizations, the Health Council sponsored a series of six interactive forums addressing a range of health-related topics and received some surprising and interesting new ideas and viewpoints to pull into the mix.

Elder Services Summit - The Council's Elder Affairs Committee and the County's Associate Commissioner for Elder Affairs produced a day-long summit on health and human service issues/resources, including appearances by state officials in the field with a willingness to help Island elders.

Oral Health Assessment - The Oral Health Working Group put together a successful grant application to Delta Dental to support planning for an Island-wide Oral Health Plan, and conducted an assessment of Islanders of all ages to be published soon and incorporated in designing the broader plan. Early results indicate huge access barriers to dental care, particularly among low-income, uninsured residents.

Youth Risk Survey and Community Meeting - The Youth Task Force's survey and October summit produced both good data and keen interest - notably among teens themselves - in moving forward on a ten-year plan to address the needs of youth and families.

UMass Medical School Clerkship - With the support of the Mental Health and Substance Abuse Committee, a group of medical and graduate nursing students conducted a two-week assessment of the community's practices in identifying residents with mental health and substance abuse issues.

Rural Public Health - As the year closed, a new Island-wide committee on public health, to include Council membership and support, was being formed under the direction of the County's Commissioner for Public Health Access. The committee will advise the new work of laying out public health goals, processes and infrastructure going forward.

Prospects for 2006

Directed by data gathered in various assessments and surveys conducted in 2005, conclusions drawn by appropriate Council work groups and committees, public input given during the Health Forum series and work already underway, we can look to the near future to see:

Medical Interpreter Services - As part of the same federal grant that allowed us to create the rural health clinic, with further funding from the Blue Cross Foundation of Massachusetts, a new community-based medical interpreter service will open for business early in the year, under the auspices of Island Health, Inc.

Rural Health Network Planning - Work will continue, the community will be engaged via focus groups and key informants, and planning group members will evaluate needs and models for primary care delivery. Further funding and support for network development and implementation will be sought.

Next Phase Health Forums - The Health Forum committee will make specific recommendations to the Health Council in January concerning issues/ideas raised during the series, and the Council will direct the recommendations to the appropriate committee or workgroup. Plans are underway to produce a regular forum series on local public television, to address a larger "healthy community" agenda.

Island Health Plan - As the dust settles and the legislature chooses a statewide direction, the Island Health Plan and its partner Neighborhood Health Plan are poised to lead the pack for expanded affordable health insurance.

Oral Health Plan - Design and implementation of an Oral Health Plan, to work in collaboration with the Council and Martha's Vineyard Hospital's re-opening of the Dental Center, has already begun. Data from oral health assessment will be published.

Youth Task Force - The task force will move ahead to lay out its ten-year plan. Ideas that will be developed include mentoring program, total community responsibility for kids ages 0-25, the involvement of elders in the community.

Mental Health Screening Tool - As recommended by the UMass Medical Clerkship group, we will research available screening tools for mental health issues, particularly substance abuse and depression and recommend its Island-wide adoption, particularly among primary care providers.

Rural Public Health Development - We hope to see the beginnings of a public health database and infrastructure, and will work together with the county officials to identify goals, methods and outcomes.

Martha's' Vineyard Health Report - The Health Report Committee, under the Foundation for Island Health, is hopeful that early in 2006, the formal publication of the Health Report will be completed and available.

Cynthia Mitchell is the Executive Director of Island Health, Inc., and the Chairman of the Dukes County Health Council.

MV Hospital: Martha's Vineyard Hospital looks to its future

By Tim Walsh

As the Island nears the end of another year, we at Martha's Vineyard Hospital look back with pride at our many accomplishments and look forward with great anticipation to the New Year.

By the end of 2005, the hospital will have cared for more than 1,329 patients on an inpatient basis and handled more than 15,523 visits to our Emergency Room by year-round and seasonal residents and Island visitors (see charts).‑

In 2005 our hospital was honored to be named a J.D. Power and Associates Distinguished Hospital, an award for overall excellence based on professional surveys.‑

As 2005 ends, the hospital and our community will say goodbye to Bill Tsikitas and Ilene Klein, two well respected physicians who have contributed much. We will also welcome four new primary care doctors we recruited to meet an overall community need for primary care.

The hospital has partnered with Cape Cod Health Care to provide Oncology services and is working with the state Department of Public Health (DPH) to become a Primary Stroke Center.‑ We have received funding via DPH to purchase equipment and train staff to respond to a bio terrorism threat and developed a business plan to open a Dental Clinic.

The Diagnostic Imaging Department purchased advanced imaging equipment including an Eight Slice Computerized Tomography (CT) Scanner, Ultrasound Recorder, Bone Densitometer and Cardiac Ultrasound Unit costing more than $1.4 million.‑ Additionally, we brought Magnetic Resonance Imaging (MRI) to the Hospital for the first time and now have MRI available weekly.

In the Emergency Department ,the Emergency Room is now staffed by full-time board certified‑ physicians 24 hours a day, seven days a week.‑ Recent technological advances enable us to connect directly with our tertiary hospital partners in Boston for real-time consultations in any emergency.‑ We have also recruited five new physicians specifically to staff the Emergency Room.‑

Additionally, two new general surgeons have been added and a new OB/GYN was hired to head our newly created Women's Health Services Department.‑ There are now 65 physicians on the hospital staff.

We have also continued to build upon our partnership with Massachusetts General Hospital to enhance our diagnostic and emergency medicine services.‑ We contract to staff our Diagnostic Imaging Department with MGH radiologists and provide real-time consultations from Boston using a direct high-speed connection.‑ We also contract with the Department of Neurology at MGH for our groundbreaking stroke protocol program.‑ This innovative program uses telemedicine to enable MGH neurologists 80 miles away to interview patients in our hospital via television while simultaneously viewing brain images sent to them from our CT scanner.‑ Finally, Martha's Vineyard Hospital has become a Planetree Hospital affiliate.‑ Planetree is a patient centered model of care that integrates the best of Western scientific medicine with time-honored healing practices.

In contrast to the 1990s, in 2005 we operated the combined facilities of Martha's Vineyard Hospital and Windemere Nursing and Rehabilitation Center "in the black," albeit by the narrowest of margins.‑ And we continued taking steps to provide the Martha's Vineyard community with a state of the art facility that will serve our health care needs through the first half of the 21st century.

In 1920, 10 Islanders incorporated Martha's Vineyard Hospital. The doors opened in 1922.‑ Shortly thereafter the community outgrew its small hospital and a new one, built on the current site, opened in 1929.‑ By the early 1970s the demand for services had again outstripped capacity, and in 1974 the hospital as we now know it was completed.‑ Today, the Island once again finds itself in circumstances similar to those of 1929 and 1974. Time and the effects of our maritime weather have also taken a severe toll on our current physical plant, and our outdated infrastructure has left the hospital unable to take advantage of some of the latest trends in patient care.

Planning has been underway for some time for new ways in which to deliver services and a new space within which to deliver them.‑

The new hospital envisioned by our architects after spending many hours with department heads, doctors, nurses and staff will consolidate patient care in a new structure which will allow for greater efficiency and effectiveness.

The new construction and renovations necessary to maintain Martha's Vineyard Hospital will cost more than $42 million.‑ This proposal creates new space for clinical services while utilizing renovated space in the old building for administration, physician offices, rehabilitation services, dialysis, and pharmacy.‑

The first floor of the new hospital will house the emergency, diagnostic imaging and surgery departments, pre- and post-op, endoscopy, laboratory and admitting.‑ the ambulance entrance, emergency room walk-in entrance and main entrance will all be adjacent to, but distinct from, one another.‑ The second floor of the new hospital will house inpatient medical surgical beds, the intensive care unit and the women's health services department.‑ The flow of patients within and among the several services in the new hospital will be more efficient and patient-friendly.

The hospital has looked at various forms that it and Windemere could take, including that of operating at different locations; but we always come to the same conclusion.‑ Operating Windemere separately from the hospital is not a financially sound option.‑ Indeed, it is only cost savings created by the sharing of services between the hospital and Windemere which make it possible to continue to operate a full-service skilled nursing facility.

Looking at the possibility of moving to a new site meant that we would now need to build an additional building to house these administrative and other services.‑ In addition to this administrative building we would also need to construct a new building for Windemere or forfeit the efficiencies gained by sharing services (dietary, administrative, human resources, payroll, waste water treatment, etc.).‑

The cost of building both an administrative building and a new nursing home building in addition to our proposed clinical services building would be in excess of $70 million - an amount that is not financially feasible.‑ After much deliberation and analysis, we concluded that building on the existing site would give us everything we need, now and for the foreseeable future, at a price that would not jeopardize the mission of either the hospital or Windemere.

Next year promises to be an exciting and eventful year for the hospital.‑ We will continue to develop and expand our primary care physician group to service all the needs of the community, we will open the dental clinic at the hospital, and we will finalize our arrangement with the Cape Cod Health Care Oncology Group to provide oncology services at MVH.

Under the direction of our skillful capital campaign co-chairs, Warren Spector and Frank Biondi, our $42 million fundraising effort has just reached the $30 million mark.‑ Raising the remaining $12 million will be challenging.‑ The hospital will need the help and support of all Islanders to meet its goal.‑

We will continue our effort with the new building project to gain approval of our plan from the various regulatory agencies.‑ Just this month the state Department of Public Health approved our "Determination of Need" application (a process that took over a year to complete).‑ Our work with the town of Oak Bluffs and the Martha's Vineyard Commission to seek local approvals will continue.

As we head into 2006 there is a new spirit of collaboration among administration, staff and the community in setting goals and standards for the hospital. Management and staff, in conjunction with an energized board of trustees and with significant input from our patients, are formulating a new vision for Martha's Vineyard Hospital.

The only way to ensure the hospital's future is for all of us to make a commitment to improve every aspect of hospital operations and management and to the delivery of high-quality health care.‑ We have set our sights on being the best small community hospital we can.

The prospect of Martha's Vineyard without our hospital is unacceptable and forces us to remember that we live on an island seven miles at sea where there will always be times when our very lives are dependent upon its existence, and on the quality of its services.

On behalf of the board of trustees, the medical staff, and the employees of the hospital, I extend my thanks and appreciation to the community for your continued support.

Tim Walsh is chief executive officer of the Martha's Vineyard Hospital

Housing MV: a long road to community restoration

By John Abrams

Think back to the winter of 2000, five years ago. Do you remember what was happening with affordable housing? I doubt it - the issue was only sporadically in the news. We had few good models, few functioning town affordable housing committees, no town funding, no full time staff at the Regional Housing Authority, no Island Affordable Housing Fund, no Island Housing Trust, no Habitat for Humanity, no down payment assistance programs, no tested deed riders to assure affordability, no rental conversion program, no house moves program, no housing developments planned on town lands.

Then, in May of that year, the seminal one-day conference Preserving Community: Housing Our Island Families happened, at precisely the right moment. Organized by a small committed band of advocates led by Juleann VanBelle, Derrill Bazzy, Zee Gamson, and Susan Wasserman, the conference inspired a much larger collection of people to act. It was a critical turning point. The Business Initiative for Housing Solutions organized itself to provide funding for the Regional Housing Authority. SHAC (remember that - the Secure Housing Action Committee?) energetically raised awareness. The Island Affordable Housing Fund, which was just forming, suddenly became supercharged. Everything changed. Small successes began to have big ripples.

2005 was like that year - another time of dramatic and fundamental progress. The passage of the Community Preservation Act and the endorsement of the Housing Bank in all six towns is a new hinge point. These new funding mechanisms will, again, raise the temperature for affordable housing on the Vineyard. At this very moment dedicated Islanders are making the rounds at Beacon Hill to promote passage of our Housing Bank bill. You can join them.

Although it may seem that affordable housing progress is slow, the years between 2000 and 2005 have been times of leaps and bounds.

In 2001 the Island Affordable Housing Fund commissioned an Island-wide housing needs assessment. Consultant John Ryan painted a picture of a stark crisis with larger dimensions than we had previously known. This year we commissioned an update. In it, Ryan says that market forces are accelerating housing difficulty, but he also says, "The Island's residents have made remarkable progress, creating 95 new affordable ownership opportunities, 83 year-round rentals, with another 165 units permitted, in litigation, or in construction. Much has been done," he says, "and there's reason to hope and celebrate."

Let's take this moment to hope and celebrate (but not to rest).

There are a host of exciting collaborations in progress. The Island's housing organizations and towns work remarkably well together. New faces are bringing expanded perspectives. The public has begun to understand the distinctive roles of the primary Island-wide organizations devoted to family housing: the Island Affordable Housing Fund raises money, the Island Housing Trust develops housing, the Regional Housing Authority manages housing. Money, housing opportunities, and management - these are the three essential components.

All is not rosy, however. This road has potholes.

Usually, when affordable housing is proposed, complaints quickly follow - that's a train that seems to always arrive on time. Sometimes the criticism has basis, sometimes not. Sometimes neighbors are not given due respect. Sometimes we do not do all that we should to find common ground. But I find that our regulatory agencies have taken criticism to heart, analyzed the issues thoroughly, and rendered difficult decisions. Sometimes these decisions come with tough conditions. And sometimes - only sometimes, but far too often - people can't accept the rulings of their elected leaders and summarily take them to court. It may be a legal right, but by trumping democracy these individuals fleece the community. Their actions should be socially unacceptable.

Cozy Hearth, a collaboration of local electrical contractor Bill Bennett and a group of employees and other working people, is a milestone worthy of examination. The proposal just received approval by the Martha's Vineyard Commission. The process was arduous. As submitted, the project represented a great idea, a fine collection of Vineyarders, and a mediocre plan. As approved, it remained a great idea (one to emulate), a fine collection of Vineyarders, and a far better plan. It got there because a committed and flexible developer was willing to learn from, and work with, an engaged group of commissioners who would spare no effort to reach a fair decision. Questions remain. Did the MVC observe the first rule of intelligent tinkering - that is, have they saved all the parts? Will the abutters accept the well-considered decision? We don't know these things yet.

The issues were difficult, the opponents made strong arguments and good points, but the MVC, by it's vote, made an immensely important statement. My interpretation of their decision goes like this: they are saying that, in some cases, even though the detriments are obvious, the need is so great, and the human element so compelling, that after requiring every reasonable enhancement, we must give our blessing. The key word is reasonable. As Samuel Johnson once remarked, "Nothing will ever be attempted, if all possible objections must first be overcome."

One of the most significant conditions the MVC imposed was to make most of the houses subject to permanent affordability restrictions, instead of just a few. For the long-term preservation of the year round community, the importance of such restrictions cannot be over-emphasized. Although I have always argued in favor of affordability restrictions, I have mostly thought of them as a necessary evil. Others have taken this further, considering permanent restrictions to be a mark of second-class homeownership. I'm beginning to think differently - that they may, in fact, be moving us in a particularly healthy direction.

Due to the built-in limited equity provisions, the owners of deed-restricted houses know that it will never - most likely - make sense for them to move on the Island. For example, someone who bought a subsidized house five years ago for $135,000 could sell it for about $195,000 today, a sizable gain, but, as you and I know, that would do absolutely nothing for them in the Vineyard market - they would have to move to Nebraska to trade up. As a result, they become committed to their homes and neighborhoods in ways that others might not. They improve, and beautify, and attend to the garden. These restrictions are encouraging a relationship to real estate that is more like it was fifty years ago, before residential property became a commodity and an opportunity for financial windfalls.

Affordability restrictions can be compared to mortgages, a rather recent invention. People used to buy houses with cash. When they first used mortgages (because they were short on cash), were they considered second-class citizens? Probably, because, in a way, they didn't even own their homes; the bank did. Now, some decades later, mortgages are entirely accepted; almost everyone lucky enough to own a home has one.

That's what I think will happen with affordability restrictions. Imagine ten years from now, when there will be hundreds of restricted housing units on the Vineyard. The result will be a large group of people truly committed to their property, as small farmers have always been.

We need the restrictions, and we need the people. And very soon we need to start thinking seriously about affordability restrictions for farmland - or there will be no farms. We need them too.

These are all small parts of a complex and lengthy process. We have taken some early steps along a road that stretches out in front of us, but the boats leaving Vineyard Haven are still full of U-Hauls moving valuable Islanders away. Everyone loves immediate answers, but this is not a two- or five-year effort. If we pace ourselves, continue to collaborate and learn together, and keep making the progress we're making, in 10 years, or 25, or 50, we will have succeeded at something nobody thought possible: restoring our community.

John Abrams serves on the boards of the Island Affordable Housing Fund and the Island Housing Trust. The president and CEO of South Mountain Company, his recent book, The Company We Keep: Reinventing Small Business for People, Community, and Place, was released in May 2005 by Chelsea Green Publishing.